PubMed · 7201278
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A W Gelb, A M Lam. 1982. Pseudohypotension.. https://doi.org/10.1213/00000539-198208000-00021
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The long-term fate of the non-operated internal carotid artery (ICA) in 219 patients undergoing contralateral carotid endarterectomy was studied; 151 patients underwent serial postoperative imaging of the vessel. Cumulative freedom from stroke in the non-operated hemisphere was 99, 96 and 86 per cent at 1, 5 and 10 years respectively, giving a mean incidence of stroke of 1 per cent per annum. Only one stroke was preceded by a transient ischaemic attack and no stroke was associated with severe (70 per cent or greater) stenosis of the ICA. Ten patients (7 per cent) with initially mild or moderate disease of the non-operated ICA progressed to severe stenosis during follow-up, but only three became symptomatic and, in each case, the onset of symptoms preceded recognition of disease progression. The long-term risk of stroke in the non-operated ICA territory is very small. Of practical importance is that none of the observed strokes could have been prevented by postoperative surveillance of this type.
To determine the natural history and durability of bilateral carotid endarterectomy (CEA), we studied 27 patients who participated in a randomized, prospective, consecutive entry trial comparing vein patch with primary CEA closure. This cohort represented 20% of the 136 patients who took part in the 4-year study. Bilateral CEAs were planned at the time of the original admission in 13 (48%), whereas 14 (52%) developed late indications for contralateral CEA a mean of 27 +/- 7 months after the initial procedure. Among the 27 patients, 15 underwent alternating methods of CEA closure. During a mean follow-up of 64 +/- 7 months, five patients had six recurrences (four unilateral, one bilateral). The type of closure did not affect the recurrence rate. All recurrences were asymptomatic and measured < 50% diameter loss by duplex criteria. There were no strokes. Two other patients had late transient ischemic attacks, but neither of them had arteriographic evidence of recurrent carotid disease. No patient underwent reoperative CEA. These data demonstrate that bilateral CEA is durable. Late recurrences are rare and clinically insignificant. The higher rate of unilateral recurrence suggests that local factors play a more important role than systemic factors in the etiology of recurrent disease.